Literature Review

Pitfalls of large language models in medical ethics reasoningnpj Digital Medicine; by Shelly Soffer, Vera Sorin, Girish N. Nadkarni, Eyal Klang; 7/25 Large language models (LLMs), such as ChatGPT-o1, display subtle blind spots in complex reasoning tasks. We illustrate these pitfalls with lateral thinking puzzles and medical ethics scenarios. Our observations indicate that patterns in training data may contribute to cognitive biases, limiting the models’ ability to navigate nuanced ethical situations. Recognizing these tendencies is crucial for responsible AI deployment in clinical contexts.

Hospices navigating ethically complex end-of-life situations Hospice News; by Holly Vossel; 7/25/25 The final stages of life can be filled with challenging, nuanced situations for some patients and their families. Ensuring goal-concordant care and autonomous end-of-life decision-making requires careful ethical, legal and operational considerations. Staff education and proactive policy development are important for hospices to harness in complex situations, according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of New York State (HPCANYS). A number of difficult life circumstances can limit hospices’ ability to provide patients with care that is in line with their wishes, Chirico indicated. Hospices need to have a firm understanding of the possible ethical and legal limitations that staff may encounter, as well as establish procedures that help address them. 

Hochul weighs political risk of aid-in-dying bill Fingerlakes1.com, Seneca Falls, NY; by Staff Report; 7/18/25 Gov. Kathy Hochul is under pressure as she considers signing New York’s Medical Aid in Dying Act, a controversial bill allowing terminally ill patients access to life-ending medication, according to Politico. The bill has strong support from advocates and many voters, but faces fierce opposition from religious groups and conservatives. Hochul, a practicing Catholic eyeing reelection, must balance public opinion, personal beliefs, and political risk.

Opinion: My health and my politics walk into a doctor’s office … The Washington Post; by Kim Fellner; 7/16/25 [Note: Access is behind a paid firewall, with an option to set up a temporary free account]... My palliative care doctor and I have almost nothing in common. We’re still learning from each other. ... It began simply enough. By October, my sarcoma had moved from possibly curable to definitively terminal, and, since metastasis to the bones can be painful, my anchor oncologist offered to connect me with a palliative care doctor to help with the physical and conceptual aches and pains of dying. Which seemed like a good thing to do. ... I did not anticipate, however, that the personal and the political would collide in my doctor’s office. ... [Descriptions unfold of significant, conflicted dialogue between (1) this Jewish daughter of holocaust survivors whose life-long vocation was social justice and (2) this Christian palliative care physician who asked about mental health and then dismissed this person's primary concerns that were affecting her dying.] ... Clearly, my doctor and I shared some beliefs about the importance of the palliative approach. ... But as the doctor noted, the best palliative care goes beyond the purely physical to address the more cosmic questions of life and death, and I was uncertain we were well matched as partners for this intimate process. ... I had no idea how to proceed. ... [More descriptions.] ... And that’s where the magic happened. Within a few days, my palliative care doctor sent me back a transparent, thoughtful and moving response. ... Her courage and openness, her willingness to risk a forthright response, have precipitated a remarkable dialogue about what each of us brings into the room, and how we can honor the space and each other once we get there. ... Editor's Note: Whatever one's political or religious stance, this article is sure to spark fireworks—of conflict, dissonance, and, hopefully, powerful insight. I encourage readers to engage with it attentively, attuned to three things:

Family of brain-dead mom, Adriana Smith, inspires Georgia bill to protect pregnant patients BET*; by Jasmine Browley; 7/7/25 During a memorial to Adriana Smith, state Rep. Park Cannon unveiled new legislation aimed at giving patients and their families more control over Georgia's severe abortion law. ... Smith's case received global attention due to its unique and contentious circumstances. On February 9, Smith began complaining about headaches. The young nurse and her mother sought assistance at two separate hospitals before being discharged with medicine but no CT scan. A week later, Smith was discovered unresponsive at home, and on February 19, she was formally pronounced brain-dead and placed on life support. Her mother, April Newkirk, told WXIA that doctors at Emory Hospital claimed they couldn't legally examine any additional choices. ... In June, a few days after doctors performed an emergency cesarean surgery to prematurely deliver her baby, the young mother of two was taken off life support. ... Smith's son Chance, born at six months, weighed only one pound and thirteen ounces.  ... Cannon's proposed new law would have returned control of Smith's end-of-life care to her family, who were not consulted before physicians put her on life support to save her six-week-old fetus. ... Adriana's Law would take precedence over Georgia's LIFE ACT, ...

How long was Adriana Smith on life support? Brain‑dead nurse's baby delivered by C‑section Enstarz; by David Unyime Nkanta; 6/18/25 The 31-year-old nurse was declared brain dead early in her pregnancy—her baby was born via C-section nearly four months later, sparking legal and ethical debate. Adriana Smith, a 31‑year‑old nurse in Atlanta, was declared brain dead in mid‑February after suffering serious blood clots in her brain. Despite devastating diagnosis, she remained on life support for nearly four months—a decision doctors said was legally necessary under Georgia's strict abortion laws. This rare case of maternal somatic support—keeping a brain-dead woman alive to deliver a baby—is highly unusual. On 13 June, doctors at Emory University Hospital performed an emergency c‑section, delivering a boy they named Chance, weighing just 1 lb 13 oz (around 830 g). ... Smith's mother, April Newkirk, described the ordeal as 'torture,' saying: 'I see my daughter breathing, but she's not there.' The family maintain that they were never allowed to make treatment decisions, a situation that has deeply distressed them and prompted calls for change. 

[UK] Palliative sedation at the end of life: Practical and ethical considerationsClinical Medicine; Dr Caroline Barry MBBS FRCP LLM FHEA PG Cert; Dr Robert Brodrick MB ChB (Hons) MA MRCP FHEA; Dr Gurpreet Gupta MBBS BSc PG Cert; Dr Imranali Panjwani LLB, PGDip, PG Cert, PhD; 6/25Highlights: The aim of palliative sedation is to relieve refractory suffering with the use of medications to reduce consciousness. Where palliative sedation is being used to treat agitation at the end of life, it is important to exclude and/or address reversible causes prior to starting medication. The drug, dose and route of administration of palliative sedation may vary according to the indication for treatment. Appropriate and proportionate use of palliative sedation does not hasten death. Suffering may have different meanings for people depending on their backgrounds and life experiences.

His sick wife asked him to kill her. Now that she's gone, he says the loneliness is worse. USA Today; by Madeline Mitchell; 6/11/25 Ever since his wife died in December, David Cook feels like a stranger in his own home. ... The loneliness “is a problem,” Cook said, and sometimes he slips into dark, depressive episodes he can only shake with sleep. He avoids the living room, with the framed photos of the two of them smiling together, the new plush carpet, the television where they'd watch tennis and golf and the ghost of the recliner she used to sit in. Patricia Cook died there, so for now − maybe forever − it's off limits. ... When she went into hospice in their living room, adamant that she’d die in her own home, the pain was excruciating. “She actually, several times, asked me to kill her," Cook said. "And I didn’t even have to think about it, I just said, ‘I’m sorry.’ I said, 'I just can’t do that.’” “Do you know how hard that is?” Cook said. “When someone asks you to kill them?” ... Editor's note: Spoiler alert. David Cook did not kill his wife. Still, he asks, "What more could I have done?" Read this story to develop your understanding of the profound depths of loss for spouses/partners, especially when they have served as caregiver through challenging needs.

National group, Oregon Death with Dignity leader says ‘modernization’ bill strips safeguards The Lund Report; by Nick Budnick; 6/5/25 Barbara Coombs Lee, co-author of Oregon’s first-in-the-nation Death with Dignity law, as well as the national assisted-dying group Compassion & Choices, oppose parts of a state Senate bill that they say would remove key safeguards from the law. ,,, [The] group is “very much opposed” to some changes the bill makes, such as eliminating the “fail-safe” of requiring a second doctor vouch for the patient’s state of mind. The group does not support the bill unless it restores needed safeguards, she said. ... The bill makes the most significant changes yet to the law. It would shorten the mandatory waiting period to seven days from the current 15. It also streamlines requirements for institutions to notify patients of their Death With Dignity policies by allowing them to post notices on their websites, and permits electronic transmission of lethal prescriptions. 

Q&A with Jim Obergefell on the future of Supreme Court's gay marriage ruling, LGBTQ rights Fremont News Messenger; by Laura A. Bischoff; 6/1/25 In 2013, Ohioans Jim Obergefell and John Arthur flew on a medical jet to exchange vows in Maryland where same-sex marriage was legal at the time. With Arthur in hospice care for amyotrophic lateral sclerosis, time was slipping away for the Cincinnati couple and their home state of Ohio prohibited same-sex marriage. Days after their tarmac wedding, civil rights attorney Al Gerhardstein showed them a blank Ohio death certificate. "Do you guys understand that when John dies, his last record as a person will be wrong here, where it says marital status at the time of death?" Gerhardstein told them. "Ohio will say John was unmarried. And Jim, your name will not be here, where it says surviving spouse name." Brokenhearted and angry at the idea of not being recognized by Ohio, Arthur and Obergefell told Gerhardstein, yes, they wanted to do something about it. Arthur didn't live to see the fruits of that decision: On June 26, 2015, in a 5-4 decision in Obergefell v. Hodges, the U.S. Supreme Court decided states must allow for same-sex marriages and must recognize those solemnized in other states. Arthur died in October 2013 at the age of 48.

Assisted living facility where woman was fatally beaten operated out of 'pure greed:' Suit Delaware New Journal; by Isabel Hughes; 5/20/25 The family of an 83-year-old woman who was fatally beaten by another resident at The Summit assisted living in North Star has accused the facility and its parent company of "pure greed," claiming in a recently filed lawsuit that the previously violent assailant was not removed from the facility because he brought in nearly $400,000 for the company. The family of Shyuan Hsia who was attacked and left to suffer in her room for hours on the night of Aug. 5, 2024 filed the 84-page suit in New Castle County Superior Court in late April. ... Discovery Senior Living, the lawsuit says, "recklessly failed to remove" him, "because if they did so, they stood to lose approximately $370,000 in revenue." That number was derived from:

Hospice nurse fired after granddaughter shares video of alleged misconduct NBC WJAR-10, Providence, RI; by Leanna Faulk; 5/16/25 A hospice nurse has been fired after a Facebook video posted by the granddaughter of a terminally ill man allegedly caught the nurse verbally abusing him inside HopeHealth Hospice & Palliative Care on Main Street in Providence. Aryanna Pecoraro said she was visiting her 69-year-old grandfather, John Carney, during the early morning hours of May 3 when she overheard a nurse speaking aggressively to him through the closed door of his room. Carney had been admitted to the hospice center on April 30 and was in the late stages of emphysema. “I hear her say to my grandfather, ‘I’m not coming back into this room. I don’t care if you fall out of the bed onto the floor. I’m tired of your BS," Pecoraro said in an interview with NBC 10. “She also mocked him while he groaned in pain. I couldn’t believe someone could be that cruel to a person who couldn’t defend himself.” ... HopeHealth issued the following statement in response to the video and allegations: ...